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Birthing—by which I mean the agony, blood, and pushing part, not the ecstasy, creation, and blessed-event part—is not something that I or, I’m guessing, most theatergoers are instinctively drawn to as dramatic subject matter. Ask an audience to experience vicariously the anguish of defeat in battle, the ache of thwarted love, the misery associated with anything from a stab wound to a bruised ego, and these we’ll happily absorb. Birth, though, is somehow more private.

Attendance at real-life births is generally restricted to those directly involved—a woman, appropriate medical personnel, perhaps a mate—and dramatists have no more felt the need to violate that intimacy than audiences have clamored for them to do so. Exposure to more than a century’s worth of infirmity dramas—from Ibsen’s Ghosts to ER—may have equipped theatergoers to empathize with plucky characters in sickbeds, but it doesn’t seem to have given them an appetite for viewing what is certifiably the first dramatic moment in any person’s life. Let a mother-to-be moan for an epidural, and the rest of that particular drama tends to be curtained off from view.

So Dana Yeaton’s Midwives, based on Chris Bohjalian’s best-selling novel (an Oprah’s Book Club selection), marks, at the very least, a theatrical departure. Part courtroom drama, part mother/daughter showdown, the play not only deals with but centers on a birth that goes nightmarishly wrong on an icy night when phone lines are down and doctors are unavailable. Mark Ramont’s staging for Round House Theatre is admirably restrained with regard to specifics—blood flows, but in small amounts; labor is troubled, but screams are minimal—still, it’s fair to say the onstage delivery is depicted with realism enough to make a hospital intern queasy.

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If the birthing in Midwives looms large, it occupies a smallish part of the evening—perhaps 10 minutes altogether—and is depicted in even briefer segments. Breathing room is provided for the audience through courtroom arguments and a debate some 12 years after the fact over what exactly happened and when. Some facts are clear enough: An experienced midwife, Sibyl Danforth, believing that her patient had died of a stroke during childbirth, performed a Caesarean section in a desperate, successful effort to save the life of the baby. But with the window of opportunity short, decisions had to be made on the fly, and after the fact, questions were raised about how thoroughly Sibyl had checked her patient for signs of life before proceeding with the operation. Charged with manslaughter and dragged through a court case, she became a poster child for those the medical profession regarded as a dangerous relic of a less sophisticated past— what she terms “baby-catching.” The case ended up having many repercussions, including what Sibyl regards as a personal betrayal: her daughter Connie’s decision to study obstetrics at med school rather than following her into midwifery.

When we meet Sibyl, played with plainspoken New England reserve by Alma Cuervo, she is approaching the end of her own life at a cancer clinic. Fragile, almost bald, with translucent skin, she’s receiving chemotherapy through an IV drip attached to the back of her hand, attended by Connie (Stephanie Burden) and a bossily efficient nurse (Lynn Steinmetz). Connie has come to find out why the journals Sibyl kept as a midwife have suddenly shown up in her mailbox, and Sibyl half-acknowledges that she sent them because they need to talk about events they’ve avoided discussing for more than a decade. Also on hand, but unseen by the others, is Charlotte (Kimberly Parker Green), the ghost of the woman who died on that icy night, drifting through walls, lounging on the bed, and otherwise haunting Sibyl’s thoughts.

“These old secrets,” Sibyl says quietly. “They’re like puncture wounds. You think they’ve healed over, but…”

So she and Connie trade memories and are interrupted as those memories come to life—a panicked husband (Gene Gillette) praying his wife will pull through, a bulldog of a prosecutor (Paul Morella) bellowing accusations, a kindly old doctor (John Dow) offering Sibyl moral support, a canny defense attorney (John Lescault) advising his client to stick to the answers they’ve rehearsed. Naturally, she doesn’t. Again, there are repercussions.

With the playwright adopting a stream-of-consciousness approach to these flashbacks, the stage version of Midwives is anything but linear, so it’s helpful that Ramont’s staging is built around a radiantly compelling central performance. Cuervo’s Sibyl is so confident, reassuring, and earthy when dealing with prospective mothers (even when ignoring a crucial bit of information), that it’s easy to see why they’d put their lives in her hands. And she’s so thorough, fair-minded, and open about her own behavior that it’s equally easy to see why she’d be an immense danger to herself in a courtroom. The tragedy didn’t destroy her, but her response to it could very well do her in, and that possibility gives the evening much of its dramatic tension.

The rest comes from the natural delays of birth—delays that are here interrupted and extended in ways that create their own dramatic arc: a labor filled with more than the usual pain, followed by a delivery that is every bit as catastrophic as the play’s setup promises. We see a few early signs that things are going wrong, have a chance to consider how they might go further wrong, examine them going wrong again, from the perspective of the husband. All this, on a stage framed by James Kronzer with seemingly sterile walls that conceal a dense Vermont forest, made visible whenever Matthew Richards’ lighting turns the walls transparent during flashbacks.

The effect is remarkable. The mother–daughter discussions that take place in the cancer clinic—arguments about medicine, law, and relationships—are enclosed within recognizable boundaries. This is where stage drama normally lives, and it’s framed in Midwives in the familiar guise of melodrama. But the birth in Charlotte’s rural home appears to be taking place in a spot so remote, so distant from any possibility of assistance, that when things go awry, there’s nothing to hang onto, either for us or for the characters. The baby-catcher’s manner remains reassuring, her tone professional as she says “Get me the sharpest knife in the house.” The other characters do as she requests, placidly though with rising panic. And on both sides of the footlights, it’s white-knuckle time.CP